7196 A randomized comparative study of percutaneous endoscopic gasrostomy and gastro-button system.

Background:We have carried on percutaneous endoscopic gastrostomy (PEG) to the 27 dysphagic patients of our hospital these 4 years.Moreover in some cases we replaced the gastro-button(G.button) system (C.R.BARD,Inc.) following PEG.We report the advantages of this system.We used the "pull" method of PEG technique. Materials and Method:A total of 27 patients with impaired swallowing were consulted for PEG placement these 4 years. (age:50-92 yrs.,mean age:70yrs.) male:7,female: 20. The previous 9 cases were fed by PEG for the early 2 years. In the following 2 years we replaced G.button system for the other 18 cases instead of PEG feeding. The underlying diseases of PEG group were cerebrovascular diseases (CVD):4,dementia:2, Parkinson's disease:1, neoplasm:1 other:1,age:50-91 yrs. mean:70.5 yrs.The underlying diseases of G.button group were CVD:14,Alzheimer's dis.:2,brain tumor:1, other:1,age58-92 yrs. ,mean:73.6 yrs.,male:3,female:15. Results:The complications of PEG group were some esophagitis (LA-classification; grade0:5, gradeA:1, gradeB:1,gradeC:1,gradeD:1),aspiration pneumonia:4,The durations of PEG were from 1.5 months(M) to 10M and mean is 3.5months. Five of 9 cases were dead within 1 year since PEG placement.The other 4 are still alive.(mean survival:2.5M)Those of G.button group were a few esophagitis(LA classification;grade 0:14,grade A:2,gradeC:2) some gastric or duodenal ulcers(n=4),aspiration pneumonia(n=8) Seven of G.button group died from 3M to 22.5M since G.button replacement.(mean duration is 8M) Eleven of G.button are still alive.The durations of G.button group are from 0.5M to 28M ,mean is 11M.Two cases(1 of NG and 1 of PEG)were taken care of at home.Moreover,G.button is also recommended from an aesthetic point of view. This G.button system may be used more and more as a home nutritional support in the future. Conclusion:This study indicates that Gastro-button system would rather be recommended as a long-term nutritional support especially at home than PEG.